National Defence Committee on March 20th, 2013

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

You want a profile.

[Pierre Daigle]

Yes. This database would give us a pretty good scope of how many people we'd be looking at. People say we need $50 million for mental health care. To do what? To treat how many people? To put where?

A base commander told me once that the allocation of resources is not proportional to the requirements. On some bases you have more people suffering from PTSD and on others there are fewer, but it seems that there's a one-size-fits-all approach. You need to look at all this and identify the scope of your problem. The answer we received was that when people are sick, we take care of them. I understand that, but you need to be more proactive, to be a bit ahead of the curve when things are coming up.

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

Please be brief.

[Mary Kirby]

At the sessions we had with Colonel Darch, the director of mental health, and Colonel Jetly, senior psychiatrist and mental health adviser, Dr. Jetly was unequivocal that he doesn't need to know that, and that he manages by wait time and makes adjustments accordingly as he sees the wait times going up and down. In relation to that, we went across the country from base to base, and we met with all of the base surgeons. They told us that they were measuring by third next available wait time, and that they would report to the surgeon general based on that.

What we discovered along the way was that mental health was being measured by first available wait time. Primary care had told us they don't measure by first available wait time because it gives a false positive. There could be a cancellation the next day. It's not something you could stand on consistently as a guaranteed measure of where you are in the system, so they were measuring by third available wait time because that was the most consistent counted-on time in the system.

We raised this with Dr. Jetly when we came back. We noted the dichotomy between the two approaches. He agreed that it was likely a false positive, and that they would be changing it to third available wait time. To the best of our understanding, in May 2012, when they had their team lead meeting in Ottawa, they were moving to that. From there on in, they were going to discuss with their team leads what they were going to measure.

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

Without reliable data and without national standards for analysis—Mr. Norlock actually might be right—none of us will actually ever know, because there's no consistency either in the collection of the data or in the analysis of the data.

[Mary Kirby]

What I can actually tell you is that there was inconsistency in that data. The data that was being reported was not consistent in that some clinics were reporting on a regular basis, and some were not, so you couldn't really get a consistent picture as to what was being collected.

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

I have a second question. With respect to your recommendation number six, you're in effect asking for consideration of a more modern application of the principle of universality. I think I know what that means, but maybe I should ask you what it means.

[Pierre Daigle]

If you look at our report, we made six recommendations. The first four recommendations were agreed to by the CDS and the Canadian Forces. The fifth one was agreed to halfway, because it has to do with the relations between the commanders and the doctors in terms of sharing information. The sixth one was not agreed to. It was to have a look at the modern application of universality of service. We all know and we are very much cognizant and supportive of universality of service. When you join an armed force, an organization like that, you have to be in shape regardless of the trade classification you're working in. The first thing you have to be able to do is be a soldier and defend and fight for your country.

We find as we go around the country, and we try to go often, that there's a perception that exists. In fact among people who are injured, the perception is growing that the CF is no longer loyal to them in the sense that yes, some people will be kept in the system, but others won't be kept in the system. We tell the Canadian Forces and the leadership that they need to be aware of this, because this is repeated to us with a lot of emotion.

Talking about universality of service and keeping people in when they're injured or they've lost their livelihood forever because they served their country, I would probably open the door here to a little bit of stigma. We have met with a lot of people and as I said before and you know, a lot of capability was developed across the country. The IPSCs, the integrated personnel support centres, are one example. Their mandate is to provide integrated medical and administrative support to people who are injured. People who are injured and are suffering physically or mentally are put into those units, and the objective of those units is to return them as quickly as possible to optimal health so they can resume their career.

In November and December of last year after we had done this report, we started working on the family files, looking at the impact of military on the family. In 10 of those IPSCs we visited, their statistics showed that of those going into those units to be fixed and returned to their unit, about 10%, and in some case 5%, were going back to their unit, which means that most of them are kicked out of or leave the forces.

This explains why some of them don't come forward with their injuries. They love the military and this is their career. When they are injured mentally, they prefer to try to cope with their buddies instead of going there, because they figure that they're going to lose their job.

All this shows us that there is distrust in the system. They think it doesn't take care about them and so on. With universality of service we're just saying today that maybe there are some kinds of illness...because what they're losing in their life was attributable to their service. Maybe there are ways of doing it differently without affecting the operational effectiveness.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Chisu.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Mr. Chair.

Thank you very much, Mr. Daigle, for being here today.

When you make a recommendation in your reports, what information is the recommendation based on? Perhaps you have data you are analyzing and you are issuing recommendations based on the data. What kind of data do you have and how are you extrapolating this? I'm an engineer by profession, so I'm very curious about your process. You have access to certain data. You probably need to eliminate some data which is not pertinent to the issues you are discussing. Perhaps there is obsolete data or you are applying statistical principles. You need to have a process in place for how you are reaching the recommendations. I'm curious about the process that you are following.

[Pierre Daigle]

Mr. Chair, if you look in our report, we do explain at one point how we did that. For this particular report, “Fortitude Under Fatigue”, which has to do with PTSD and OSI, as I said I have a team with different backgrounds who visited about 10 bases just for this particular issue, and we do other things. They met with about 500 people in interviews and so on and reviewed 600 documents, documents that existed also on all of this.

We make it a duty to base everything we do on facts, it has to be factual. I do not tolerate from people in our office “my impression”, “it seems”, or “it appears”. What are the facts? A lot of comments or a lot of the returns that we get from those interviews and so on, if we feel they're not substantiated or supported by a fact, we'll discard them. We don't use them in our intellectual analysis or rationalization afterwards. When we have all the facts, we come up with findings, and obviously sometimes it translates into conclusions, and then we look at what kind of recommendation we can bring forward to correct the unfairness that's there.

In this recommendation, like any other organization, we're not perfect, but what we tell the chain of command is they should.... When we look in the files, or we're doing an investigation, I have my full resources of my office to look at that. This in fact should help any leader, because I know they're all very busy and they now have a specialized independent entity that can look at all this and make some recommendations.

We do cover all the grounds. We're not medical experts. We do interview a lot of doctors and so on. A lot of comments you see in the report come from doctors themselves who tell you the problems they are facing. You've heard former surgeon general, Commodore Jung, testify on this. They do face similar problems to what we raise in our report. So, you're right, we try very hard to base everything on facts. If people question things, we can provide the documents, the interviews we did, and not just one interview, but we have to cross-reference them over many other testimonies.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Now that you have done everything and you have done the recommendation, how are you measuring your own success? What are the tools you are using to measure yourselves? You are measuring somebody else, so now let's see how you are measuring your own success.

[Pierre Daigle]

There's a way of doing that. When we produce a report, we give the system, the department and Canadian Forces, time to implement our recommendations. This particular report is our third follow-up. We started with 31 recommendations in 2002, and now we're down to six. As we move along we know there's some improvement. They amalgamate some recommendations, two into one, and we move along. We give them a year and a half or two, and then we do a follow-up to see how well they're doing. Sometimes they will tell us this is absolutely not going to happen.

We make recommendations. If we feel very strongly about it, we can escalate each one.

If your question means if I put in 10 recommendations and they agree to five of them, am I having a 50% batting average, it's very hard to say. I can't look at it that way because we make recommendations. We think it's the best way to address the fairness. We're advocates of fairness. At the end of the day everybody puts all of whatever they have in their hands, in their tools, to try to do the best they can also. If we feel strongly about something, we keep their feet to the fire by following up on it. This database, for instance, is something we keep following up on because we feel it's very important.

One of the particular concerns we have is that we were a bit afraid that the intensity of effort the CF and DND has put into PTSD and OSI would wind down because Afghanistan is winding down. There are financial realities now that people are striving to find money, and so on. We don't know the real impact of PTSD yet because it might appear in one, two, or three years down the road. You need to keep the focus on that and continue.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

I just wanted to ask how—

[The Chair, Conservative, James Bezan]

Time, sorry.

Madame Moore, s'il vous plaît.

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

Thank you.

I would like to discuss with you the written reply I received to a question I asked Colonel McLeod in November 2012. I spoke to him about the situation for reservists who live in remote areas.

Some soldiers who have served in Afghanistan live in remote areas. When these individuals return to their unit, they face problems when they try to get care. Care is not always available in their region. As we can imagine, there are not a lot of psychiatrists who specialize in post-traumatic stress syndrome outside the cities. So these people have to go elsewhere to get treatment, and in concrete terms, this means they have to take days off work. Most reservists do have civilian jobs.

In my letter, I asked whether there was some kind of financial compensation, and the answer was that in the Canadian Forces there is no program or benefit to compensate reservists directly for lost wages from a civilian job. The only compensation they receive is their salary as a reservist while they are receiving care and reimbursement for their travel expenses.

Some reservists who are corporals in the Reserve Force, for example, have a job that involves a post-graduate university degree. So these people suffer a financial loss. If they have to be absent from a job where they earn $50 or $60 an hour, or even more, and they only receive their reservist salary, it is complicated.

There are also the wives. In the case of post-traumatic stress syndrome, an effort is made to have the family participate in the treatment. But the wife does not receive any compensation.

In your opinion, are these shortcomings? If so, what could the government do to make up for them?

[Pierre Daigle]

Mr. Chair, we have not looked at the wages that reservists lose in this situation. When we prepared the report entitled "Fortitude Under Fatigue", we realized there had been no studies done about mental health care for reservists.

When reservists return from a deployment, they return to their unit, and because in many cases their job category was what is called Class A, their main medical care is provided by the province. After doing that study, we decided to do a study of the mental health care that reservists should be receiving.

In November, we also produced a report entitled "Reserved Care". That report dealt with the care offered to injured reservists in Canada, but there again, we were not looking at mental health. It talked about compensation, applying the same standards for immunization, and so on.

On the question of loss of wages associated with their main job, we did not include that in these reports, and for the moment, I do not think there are plans for that to be part of future reports.

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

In general, how could care be improved for reservists who live in remote areas, who are isolated, and who do not always have access to specialists?

[Pierre Daigle]

We are starting a study now that will be published at the end of the year, dealing with what we call operational stress injuries for reservists. We will be looking at that issue.

In the report we published in November, on medical care for reservists serving in Canada, and this was not necessarily about mental health, we recommended that the Queen's Regulations and Orders for the Canadian Forces as they relate to reservists be amended.

First, some doctors do not know what care they are entitled to provide for reservists, and some reservists do not know what care they are entitled to. As you said, when they return to the unit to which they belong, after being on an operation, they are in a more isolated situation. They are no longer supported or overseen as they were in the unit where they were deployed. In those cases, there are many of them who do not have access to these services.

[The Chair, Conservative, James Bezan]

Your time has expired.

Mr. Opitz.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, Mr. Chair, and thank you both for being here today.

Sir, I understand you have an advisory committee and they advise you and your office, not only on matters relating to the overall well-being and fair treatment of members in the defence community, but they also make observations and comments on the systemic problems within DND and the Canadian armed forces. These folks also recommend ways to deal with these issues and serve as a sounding board for various initiatives and recommendations that are considered by you and your office. This committee could arguably carry a lot of weight on how you and your office operate and make those decisions. Would you be able to describe, sir, how you put this particular advisory committee together? What types of people are currently serving under you as advisers?

[Pierre Daigle]

Based on my ministerial directive from the Minister of National Defence, in my mandate it does say that I should have an advisory committee that should meet a few times a year. It's kind of a sounding board contributing to our debate, discussion or brainstorming on how we can move and improve, or even decide on some investigation or not.

This committee has a chair and I would say you probably know him from the Office of the Correctional Investigator Canada. Howard, as a secondary duty, is my chair. We have about eight members. Before we appoint someone, we recommend their candidacy to the Minister of National Defence, and he has to approve them to be part of our committee.

In terms of saving money, we reduced from two meetings a year to only one, so the meeting we have with the advisory committee is held most of the time in October when we also hold our commendation ceremony where we recognize the contribution of some people in the department, in the Canadian Forces.

With all of the participants, we try to have a representation of all of my constituent groups, everybody who's a constituent who has come to our office to complain: military, regular, reserve. We do have a regular and reserve officer on board. We had a family member. We have a family director for MFRC, different provinces, services, officers, NCM: we try to have representation of all those who can come to our office. We brief them on what we've done. We brief them on the way ahead on some issues. We get their various perspectives and their input into how we can address some of those issues. It is really a representation of all those who can come to the ombudsman, but this is an advisory committee and they are held in confidentiality if ever we share some things that are more sensitive.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, sir.

In your report “Fortitude Under Fatigue”, it mentions the establishment of the JPSUs. There are now 34 of these JPSUs across Canada, which essentially offer a one-stop shop for help and support for our men and women in uniform.

Recently this committee heard witness testimony about the effectiveness of these particular establishments and what they're able to do in helping with operational stress injuries that our service personnel come back with. Can you describe, sir, how that idea of the JPSU was developed and basically how it's been received overall, in your opinion, by the DND community?

[Pierre Daigle]

I will ask Mary to expand on what I'm going to say.

Obviously, as I said before, from 2002 to 2008 there weren't a lot of initiatives by the department. A lot of effort, money, and initiatives have put services in place for the ill and injured across the country to replace an ad hoc organization trying to streamline and organize. IPSC is the integrated personnel support centre, and there are many IPSCs reporting to a JPSU. There's only one JPSU, joint personnel support unit, headed by a colonel here in Ottawa. I think you've met Colonel Blais and Admiral Smith. They are in Ottawa. There are IPSCs across the country, and they report to places called JPSU regional. Their main purpose, as I said before, is to provide care and administration to those who are suffering.

In the old days we called that SPHL, service personnel holding lists. When you were unfit to work, you were put into this special unit until you were fit and back in your unit. Now they have created this for all kinds of injuries, but a lot of mental health injuries are passing through. Their aim is to try to bring individuals to optimal health so they can resume their career or be prepared for transition to civilian life.

As I said before, in the past year the statistics we had from 10 of the IPSCs and JPSUs indicated a bit of concern from members themselves about why members may not come forward with their sickness, because only 5% or 10% are eventually returned to their units. Some of the troops prefer to stay within their units, care for their own, stay with their buddies, and so on, rather than go there because they are afraid it will be the kiss of death and they will be released from the forces, and they do love the forces. They do love their jobs and they want to stay in them.

Can you add anything to that, Mary?

[Mary Kirby]

I would just like to add that—